Computed tomography of malignant pleural mesothelioma

Our plain-English summary of Computed tomography of malignant pleural mesothelioma, by D.C. Grant, S.E. Seltzer, K.H. Antman, et al (Journal of Computer Assisted Tomography, 1983).

The study

• Authors: D.C. Grant, S.E. Seltzer, K.H. Antman, H.J. Finberg, K. Koster
• Journal: Journal of Computer Assisted Tomography
• Published: 1983;7(4):626-32
• Cited by: 36 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We tabulated the computed tomographic (CT) findings in 14 consecutive patients who had proven malignant pleural mesotheliomas and were studied over a 3-year period. We also staged the disease in these patients, all of whom were men, aged 40-75 years (mean, 59), and had been exposed to asbestos at work. Common presenting symptoms were shortness of breath or chest pain. Pleural thickening was found on the side of the tumor in all of the patients, characterized as nodular and circumferential (6/14 cases), plaque-like (4/14), or strictly nodular (4/14) in appearance. In addition, 86% of the patients demonstrated contralateral pleural thickening, but these lesions did not prove to be tumor deposits. Other common CT findings in the involved hemithorax included: pleural effusions (79% of cases), lung parenchymal disease (79%), decreased hemithorax size (62%), and pleural calcification (50%). Before the chest scans were performed, 13 patients were felt to have Stage I disease and one to have Stage IV. The CT information revised these opinions: four of the Stage I patients were assigned to Stage II (on the basis of chest wall involvement or enlarged hilar/mediastinal lymph nodes). Therapy was altered in these four cases. In two patients pericardial thickening was seen, but it was not possible to determine if this was due to tumor involvement. We conclude that CT can identify several abnormalities that are commonly associated with mesotheliomas. By demonstrating lesions not detectable on conventional imaging studies, CT may alter staging and therapy in many patients with this disease.

In plain English

This case series described chest computed tomography (CT) findings in 14 men aged 40 to 75 with tissue-confirmed malignant pleural mesothelioma. They were seen at a Boston hospital over three years beginning in 1979. All had been exposed to asbestos at work, as shipyard workers, pipe fitters, insulation workers and in other jobs. Fiber types were not reported. The tumor appeared as round nodules (4 of 14 patients), flat plaque-like areas (4 of 14), or nodules on diffuse thickening around the pleura (6 of 14). Pleural effusion and lung involvement were each seen in 11 patients (79%), and pleural calcification in eight (57%). Enlarged hilar or mediastinal lymph nodes were seen in four, chest wall spread in two and liver metastasis in one. Plaques on the opposite pleura were seen in 12 of 14. Before CT, 13 patients were judged Stage I and one Stage IV. CT moved four Stage I patients to Stage II, and planned surgery was cancelled for them. The authors noted that asbestos-related plaques and other tumors can resemble mesothelioma on CT. They concluded that CT can identify abnormalities associated with mesothelioma and may alter staging or therapy.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case series: review of chest CT scans (and conventional radiographs) of patients with malignant pleural mesothelioma, with disease staging before and after CT
• Who was studied: 14 men aged 40 to 75 years (mean 59) with histologically confirmed malignant pleural mesothelioma, seen at Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, over a 3-year period beginning in 1979
• Exposure: Occupational asbestos exposure in every patient. Jobs listed include shipyard worker, pipe fitter, steam fitter, post office worker, boiler room worker, naval yard worker, insulation worker and shipyard officer. Fiber types and doses were not reported.
• Main results:
  • Pattern of pleural abnormality: focal round tumor nodules with normal-appearing pleura between them in 4 of 14 patients (29%)
  • Pattern of pleural abnormality: focal flat plaque-like areas of tumor in 4 of 14 patients (29%)
  • Pattern of pleural abnormality: round tumor nodules on diffuse, circumferential pleural thickening in 6 of 14 patients (43%)
  • Pleural effusion on the side of the tumor in 11 patients (79%)
  • Pleural calcification in 8 patients (57%); in 7 of these, the calcification seen on CT had not been apparent on earlier chest X-rays
  • Lung involvement on the side of the tumor in 11 patients (79%)
  • Lung nodules in 8 patients (57%), multiple in 3 and solitary in 5; in 6 of the 8 they were not seen on conventional radiographs
  • Enlarged hilar or mediastinal lymph nodes in 4 patients (29%); in 2 of these they were not detected on chest X-ray
  • Direct spread of the tumor into the chest wall in 2 patients
  • Liver metastasis in 1 patient
  • Plaques on the opposite (contralateral) pleura in 12 of 14 patients
  • Before CT, 13 patients were judged Stage I and 1 Stage IV. CT information moved 4 Stage I patients to Stage II because of chest wall or lymph node involvement.
  • Therapy was changed in those 4 patients: planned surgery was cancelled when disease was shown in the chest wall or lymph nodes
  • Two patients were placed in Stage II only because of pericardial thickening. It could not be determined whether this was tumor or nonspecific fibrosis, and their therapy was not changed.
• The authors' conclusion: The authors concluded that CT can identify a number of abnormalities associated with mesothelioma and, by showing lesions not detectable on conventional imaging, may alter staging or therapy in patients with this disease
• Limitations the authors state:
  • Because the tumor was diffuse or multifocal, the margins of tumor deposits were often difficult to determine
  • Pleural plaques associated with asbestosis can mimic the tumor deposits of mesothelioma, and the authors found it often impossible to tell the two kinds of pleural thickening apart
  • Metastatic tumors involving the pleura can produce all of the CT findings of mesothelioma

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Pleural Thickening, Hemithorax, Pleural Effusion, Pleural Calcification, Mediastinal Lymph Nodes, Pericardial, Mesothelioma.

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